Provider Demographics
NPI:1124191770
Name:ROSE, SEAN PAUL (LHIS)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PAUL
Last Name:ROSE
Suffix:
Gender:M
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2137
Mailing Address - Country:US
Mailing Address - Phone:254-235-3783
Mailing Address - Fax:254-235-6265
Practice Address - Street 1:105 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2137
Practice Address - Country:US
Practice Address - Phone:254-235-3783
Practice Address - Fax:254-235-6265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50674237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50674OtherFITTING AND DISPENSING #
TXTXV06152OtherSTAP VENDOR ID#